$20 Dissertation

STD rates among adolescents and young adults in Baltimore, MD & the impact, interventions Introduction The adolescent and young adult population is particularly vulnerable to sexually transmitted diseases (STDs). Teens often lack information about sexual health issues and are at a greater risk of becoming infected with an STD or HIV/AIDS due to lack of access to sexual health information and services (Alhassan, 2019). In addition, peer pressure and lack of control over their own sexuality increase teens’ risk for acquiring an STD. Therefore, it is important to understand the factors that play a role in promoting sexual risk behaviors among youth in order to develop effective prevention and intervention strategies to reduce the spread of STDs. Teen pregnancy and STDs have been on the rise since 2010, but efforts have been made to promote healthy sexual behaviors (Ljubojević, 2010). Cities across the United States have implemented various prevention programs targeting youth to reduce the rate of teen pregnancy, but research on the effectiveness of these prevention programs is limited. The rates of STDs in adolescents and young adults are continuously on the rise, affecting over 1 million people annually. Baltimore faces a number of public health problems including drug addiction and HIV, which correlate with other STDs in adolescents. The project is aimed at increasing awareness and providing services to help reduce sexually transmitted infection (STI) rates within Baltimore City (Hsu, 2022). Many people who contract a sexually transmitted infection (STI) do not have an awareness of the disease or are not willing to seek medical attention. A large part of the transmission occurs through infected partners with no knowledge of their status. The project aims at educating these individuals regarding their risk and decreasing their rates of infection by providing quality healthcare. According to the CDC, Baltimore has 3,707 reported cases per 100,000 people and is the second highest city for sexually transmitted infections rates in the United States (CDC, 2022). A collaborative approach with the Baltimore City Health Department and local clinics will be used to provide education to prevent the spread of STDs. The project will also assist in identifying at risk individuals and providing intervention services. There are several areas to address within the community to reduce the spread of STIs significantly such as economic, social, and behavioral factors. Majority of the prevalence of STIs is affecting those in poverty with limitations on access to quality health care. The prevalence of adolescent and young adult STD rates is on the rise and adversely affecting the health of the local population. Therefore, it is important to understand the factors that play a role in promoting sexual risk behaviors among youth in order to develop effective prevention and intervention strategies to reduce the spread of STDs. Identification of key stakeholders Stakeholders are essential to this project because they have the resources and knowledge to improve the lives of others. All stakeholders who provide services to the population are key. The populations at risk for STIs are adolescents, young adults, and women who are of reproductive age (Grieb, 2018). Local Health Departments and clinics have a large client base with access to individuals who will be educated about STIs. The stakeholders will be identified through the Baltimore Health Department and by visiting local clinics that may provide testing and treatment of STIs. The stakeholders with be asked for their input and participation in the project. The populations that are more at risk for contracting an STD are those who may not have access to health care and lack knowledge about the disease. Engaging these individuals is essential to ensure that they will receive treatment if infected. Non-traditional stakeholders like churches, schools, barber shops, restaurants, and even social media sites will need to be used for educating individuals about the risks of STIs in Baltimore City, whom will be identified by Baltimore Health Department. These non-traditional organizations are located mostly in poverty stricken areas where high rates of STIs occur among adolescents. These individuals are the most at risk, with limited knowledge of their status and often unaware that they could be infected. Education, testing, and treatment will allow users to have increased access to quality healthcare. Community assessment (Phase 1) The community of Baltimore City is a large part of this project and educating the community will be essential to reduce the spread of STIs. This can be done through utilizing non-traditional organizations that have a high concentration of individuals at risk for contracting an STI. The community of Baltimore City as a whole has an accumulation of non-traditional organizations that can be used to educate individuals about STIs (Burns, 2020). These non-traditional organizations are smaller and have limited resources, but they are located in the city where most of the infections occur. Such organizations will be key members to provide awareness and testing for the project. Planning grant money is allotted for community outreach and education. The project hopes to distribute educational pamphlets, flyers, and posters throughout the city to ensure that all individuals will have access to information. The Baltimore Health Department is working with local clinics to identify the needs in their communities and will be able to answer questions regarding testing and treatment of STIs. The local clinics are essential members of the community because they are located within Baltimore City and serve Baltimore residents. The health behaviors and lifestyles (Phase 2) The health behaviors and lifestyles that most clearly influence the outcome the community seeks that must be changed to affect the issues are sexual activity among adolescents and young adults, alcohol consumption, drug use, and smoking (Young, 2018). These health behaviors have been found to have a profound impact on the spread of STIs. The issue of drug use is a key component in this project because it indirectly affects the spread of STIs. Within Baltimore City, many adolescents and young adults are using drugs and alcohol as a form of self-medication to reduce DOMS, one of the important indicators for HIV infection. To reduce the risk of contracting an STD will require integrating prevention services to minimize the use of drugs and alcohol in adolescents, particularly identifying those at risk for contracting an STI. The majority population that engages in risky sexual activity is teenagers who are most likely to contract an STD. The project will work with Baltimore City Public Schools to educate students about STDs. The Baltimore Health Department will distribute educational pamphlets in schools, a community worker or volunteer from the project will sit down with the students and answer their questions such as what are the risks of STIs, how long does it take for a person to develop an STD, and how early should you know if you have an impurity (Ware, 2019). The community worker or volunteer will also provide males and females with condoms, which can be used for low-risk sexual activities. Project Goals The project will accomplish three objectives, which will address the key health issues of Baltimore City. In addressing the issue of STIs, the project will accomplish three short-term and one long-term objective. The primary short-term goal is to ensure that all individuals within Baltimore City are educated about safe practices and STDs. The intermediate goal is also essential to reducing the spread of STIs as it will help individuals identify an infection and treat it accordingly. It is safe to say that if individuals are able to take a test for an STD and know when they have been infected, they will be able to get tested when needed for treatment. The long-term goal is for all individuals in Baltimore City to be tested for an STI when needed and treated accordingly. The project will strongly focus on educating adolescents because their health behaviors are key drivers in the problem of STIs. Baltimore City is a largely youthful community with a high number of individuals in the 15-24 year old age group. The project will educate adolescents on the risks of STIs, how to reduce their risk, and provide them with condoms to reduce the spread of an STD. The predisposing, enabling, and reinforcing factors that act as supports for or barriers to changing the behaviors and environmental factors you identified in Sections 1 and 2 (Phase 3) The project will find several factors that act as barriers to reducing the spread of STDs. The most prominent barrier is peer pressure, which is a key issue in Baltimore City. Peer pressure results in adolescents having sex with individuals who have STDs and possibly spreading it to other individuals. The behavioral change process will be a challenge for this program because it deals with personal behavior such as drug use, smoking, and risk-taking sexual activity among adolescents and young adults. While peer pressure is a key player in these behaviors, there are other factors that serve as barriers to change such as lack of knowledge about the risks associated with an STD and the fear of being labeled or judged by peers or family members. Also, individuals are unaware of the importance of being tested for an STD. The most prominent factor that acts as a barrier to changing risky sexual behaviors is lack of awareness and knowledge. These individuals do not feel comfortable seeking help because they are not educated on how to decrease their risk or how to reduce their partner’s risk. Other barriers to changing these behaviors includes lack of access to health care, lack of knowledge about emergency contraception (EC), and a lack of understanding that an infection can last years when left untreated. Intervention Plan (Phases 3 & 4) The intervention will be a community based educational program that will provide adolescents with education on the risks of STDs and safe behaviors. The project will work with Baltimore City Public Schools to educate students about STDs. The Baltimore Health Department will distribute educational pamphlets in school, a community worker or volunteer from the project will sit down with the students and answer their questions such as what are the risks of an STD, how long does it take for a person to develop an STD, and how early should you know if you have an impurity. The community worker or volunteer will also provide males and females with condoms, which can be used for low-risk sexual activities (ex: oral sex). The project will also provide adolescents with information on how early they should be tested for an STD and when to get treated for a possible infection. The project will have a strong focus on Baltimore City Public Schools because they are located in the center of Baltimore City and can reach a large amount of adolescents. Each year about 55,000 students are enrolled in Baltimore City Public Schools. Internal administrative issues that can affect the successful conduct of the intervention (Phase 4) There are several internal administrative issues that could affect the project. The most prominent issue is how to raise funds for the project. In order to raise funds for the project, Baltimore City Health Department would need to seek out funding from different sources such as community foundations and private organizations that have connections with foundations. The organization would also need to seek out grants from government agencies such as the United States Department of Health and Human Services, National Institute of Drug Abuse, National Institute of Mental Health; local health organizations; and private donors who have a personal connection with Baltimore City Health Department (Adil, 2020). In addition to seeking out funding, the project will experience several internal administrative challenges in terms of staff involvement and responsibilities. It will be a challenge to convince other employees within Baltimore City Health Department to help with this program. There are approximately over 1000 employees, which means that there will not be an abundance of volunteers for the project. Moreover, employees would need additional training and education on how to decrease the spread of STDs and the importance of treating an STD at the earliest stage possible. Another challenge is deciding on which individuals should take on a leadership role in this project and what their roles in the project are. The project will need to find community workers that are willing to sit down with adolescents, discuss the risks associated with an STD and the importance of being tested and treated. Baltimore City Health Department should also seek out individuals who have experience working with adolescents to participate in the program. The role of the community worker is to provide young adults with information about STDs in a private, confidential setting. The volunteer or community worker will educate adolescents about the risks of contracting and spreading an STD (Eaton, 2018). In addition, they will inform students how early they should be tested for an STD and when they should receive medical care if they discover that they have had sexual contact with someone who is infected with an STD. Funding and other resources for the intervention (Phase 4) Funding will be necessary because the project will need to continue to conduct research on how adolescents act in risky sexual situations, how their behaviors are shaped by their environment and peers, and other factors that lead them to engage in risky sexual activities. The project will also need money for advertising the program and distributing educational pamphlets such as condoms, MPOWERED campaign from Center for Disease Control (CDC), t-shirts containing slogans on safe sex, pamphlets containing information about STDs, and booklets explaining the importance of being tested for an STD. There are various funding opportunities available for this project including private donations from individuals or corporations who have a personal connection with Baltimore City Health Department; government grants; foundations; local health organizations; etc. Baltimore City Health Department will also need to figure out which individuals, both internal and external, are willing to help with the program. In order to hold a variety of activities including movie nights, workshops and lunches that will help promote the program among adolescents; Baltimore City Health Department will need volunteers from other departments such as the Office of Neighborhood Partnerships or Baltimore City Public Schools (Baltimore Health Department, 2018). The Intervention (Phase 5) The intervention will involve educating adolescents about STDs and teen dating violence. The project will also provide adolescents with condoms, a safe sex campaign from CDC and information on how to be tested for an STD. The first part of the project will focus on educating adolescents about STDs and teen dating violence. The community workers or volunteers will present students with posters that contain information on how to recognize an STD, the symptoms associated with an STD and the importance of being screened for an STD at least once a year. In addition, students will receive pamphlets on STDs and pamphlets containing information on teen dating violence such as how you can recognize a violent situation or abusive relationship and what steps you can take to get out of it safely. Procedure in carrying out the intervention (Phase 6) The intervention will involve identifying the adolescents who are at risk of contracting and spreading an STD. The community workers or volunteers would then set up meetings with those adolescents to discuss their risk factors and behaviors in order to reduce the spread of an STD. In addition, students will identify their friends who have risk factors for contracting and spreading STDs such as their attitude, knowledge about STDs, close proximity to sexual partners, and number of sexual partners (Pontes, 2021). Baltimore City Health Department will also distribute pamphlets including information on teen dating violence within the city high schools along with creating posters that contain the same information. The evaluation plan /the process of the intervention (Phase 7) Baltimore City Health Department will evaluate the project by interviewing adolescents and community workers who assist in the intervention (Baltimore Health Department, 2018). The project will ask adolescents about their thoughts on the program, if they feel that their behaviors have been inclined to be more cautious about sexual activity, their level of knowledge about STDs and what they think could be potential solutions to decrease the spread of STDs in Baltimore City. They will also ask community workers or volunteers to evaluate how they are addressing the problems associated with unsafe sex within different communities and how effective their strategies were. The project will also examine Baltimore City Health Department’s budget for this program. Intended impact on the behavioral and environmental (Phase 8) Baltimore City Health Department will evaluate the program by examining STD rates before and after the intervention. The city health department will also hold meetings with adolescents to understand if they are making informed decisions and have learned how to protect themselves from STDs. Baltimore City Health Department will also evaluate how much money was spent on the intervention and where it was spent. If a portion of the money was not used wisely or did not yield enough results, Baltimore City Health Department should re-allocate those resources to different programs that are more useful for their target population of adolescents. Conclusion The prevalence of adolescent and young adult STD rates is on the rise and adversely affecting the health of the local population. Therefore, it is important to understand the factors that play a role in promoting sexual risk behaviors among youth in order to develop effective prevention and intervention strategies to reduce the spread of STDs. References (CDC)., C. f. (2022). Sexually transmitted disease surveillance report . https://www.cdc.gov/std/health-disparities/cars-case-baltimore.html. Adil, M. B. (2020). Increasing access to STI services in the Medicaid program. Health sciences research commons. https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1031&context=sphhs_policy_informal. Alhassan, R. K.-F.-Y.-N. (2019). Determinants of use of mobile phones for sexually transmitted infections (STIs) education and prevention among adolescents and young adults in Ghana. implications of public health policy and interventions design. Reproductive health, 16(1), 1-11. Burns, P. A. (2020). 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